Active NPI
Andy Wong
- Pharmacist
- Berkeley, CA
National Provider Identifier
1578014304
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 74991
- Practice address
- 2001 Dwight Way Ste 2182
Berkeley, CA 94704-2608 - Phone
- (510) 204-6550
- NPI assigned
- Oct 17, 2016
- Last updated
- Sep 27, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 74991 | CA | Primary |
Addresses
Primary practice location
2001 Dwight Way Ste 2182
Berkeley, CA 94704-2608
Mailing address
PO Box 16525
San Francisco, CA 94116-0525
Other practice location 1
3100 Summit St Ste 2147
Oakland, CA 94609-3412
Phone (510) 869-8451
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 74991 | CA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1476662400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1601164800000",
"number": "1578014304",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 16525",
"city": "SAN FRANCISCO",
"state": "CA",
"postal_code": "941160525"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2001 DWIGHT WAY STE 2182",
"city": "BERKELEY",
"state": "CA",
"postal_code": "947042608",
"telephone_number": "510-204-6550"
}
],
"practiceLocations": [
{
"address_1": "3100 Summit St Ste 2147",
"address_purpose": "LOCATION",
"city": "Oakland",
"state": "CA",
"postal_code": "946093412",
"country_code": "US",
"telephone_number": "510-869-8451",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WONG",
"first_name": "ANDY",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-10-17",
"last_updated": "2020-09-27",
"certification_date": "2020-09-27",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "74991",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Berkeley, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.